Healthcare Provider Details

I. General information

NPI: 1801972906
Provider Name (Legal Business Name): SENEX FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 W 8TH DR
CRAIG CO
81625-3110
US

IV. Provider business mailing address

1625 MID VALLEY DR SUITE 1-111
STEAMBOAT SPRINGS CO
80487-9010
US

V. Phone/Fax

Practice location:
  • Phone: 970-826-4100
  • Fax: 970-826-0088
Mailing address:
  • Phone: 970-871-9988
  • Fax: 970-871-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0188
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier21675830
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: MITCHELL J FRIEDMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential: NHA
Phone: 970-871-9988